Kimia Çepni

Objective: This study aimed to evaluate the association between pretreatment hemoglobin levels and lymphocyte percentage and survival outcomes in cervical cancer patients treated with definitive concurrent chemoradiotherapy. Materials and Methods: A total of 106 patients with cervical cancer were included in this retrospective cohort study. Pretreatment hemoglobin (g/dL) and lymphocyte percentage (%) were analyzed. Overall survival (OS) and disease-free survival (DFS) were assessed using the Kaplan–Meier method, and groups were compared using the log-rank test. The effects of prognostic factors were first evaluated using univariate Cox regression analysis; variables with p<0.20 were subsequently included in the multivariate Cox regression model. A p-value <0.05 was considered statistically significant. Results: Following completion of chemoradiotherapy, the median follow-up duration was 40 months, during which 18 deaths (17.0%) were observed. Kaplan–Meier analysis demonstrated that lower hemoglobin levels and lower lymphocyte percentages were significantly associated with worse DFS and OS. In univariate Cox analysis, both hemoglobin and lymphocyte levels were significantly associated with survival outcomes. However, neither variable retained independent prognostic significance in multivariate analysis. Clinical parameters such as advanced FIGO stage and prolonged treatment duration showed a trend toward worse outcomes. Conclusion: Pretreatment hemoglobin and lymphocyte levels were associated with survival outcomes in cervical cancer patients; however, they did not demonstrate independent prognostic significance after multivariable adjustment. These findings suggest that hematologic parameters may reflect disease burden and treatment-related factors rather than acting as independent prognostic markers. Further prospective studies with larger sample sizes are needed to confirm these findings.

Objective: Neoadjuvant chemoradiotherapy (NACRT) plays an important role in the treatment of esophageal cancer. Current studies show that increased pathological response and R0-resection rates positively affect treatment outcomes. This study aimed to evaluate the clinical outcomes of patients who received NACRT with or without surgery. Methods: In this study, 72 patients diagnosed with esophageal cancer who underwent NACRT, with or without subsequent surgery, were retrospectively analyzed. Radiotherapy (RT) fields were defined based on the primary tumor location, and the median RT dose was 50.4 Gy (range: 41.4–54 Gy). The patients received a chemotherapy regimen consisting of 5 cycles of carboplatin and paclitaxel. Following CRT, patients who were eligible for surgery depending on their pathological response rates underwent surgical resection. Results: Overall survival and progression-free survival were found to be statistically significantly higher in the surgical group (P = .03 and P = .01). Overall survival (P = .001) and progression-free survival (P = .001) were significantly higher in patients with pathological yp-Stage 0–1 compared to those with higher pathological stages. Conclusion: This study highlights the impact of pathological response rates following NACRT, with or without surgery, on treatment outcomes in esophageal cancer. Cite this article as: Çepni K, Uçgun TH, Şam Özdemir M, Aydın SN, Çepni B, Kızıltan HS. Impact of response rates on overall survival following chemoradiotherapy with or without surgery in esophageal cancer. Cerrahpaşa Med J 2026, 50, 0079, doi:10.5152/cjm.2026.25079.

Background/Objectives: D-dimer, a fibrin degradation product, is associated with tumor growth and metastasis. In breast cancer, high concentrations of D-dimer are linked to more advanced disease stages and metastatic spread. This research aimed to examine the relevance of D-dimer levels in estrogen and progesterone hormone receptor (HR)-positive breast cancer. Methods: This retrospective single-center cohort study included patients with HR-positive breast carcinoma who underwent adjuvant or palliative radiotherapy in Türkiye. Pre- and post-radiotherapy blood test results, including D-dimer levels, were required. D-dimer, lymphocyte percentage, and interleukin-6 levels were measured for evaluation. All statistical analyses were performed using R software (version 4.4.2) to evaluate associations between D-dimer levels and other laboratory parameters. Univariate and multivariate Cox proportional hazards regression were performed to identify prognostic factors for progression-free survival (PFS) and overall survival (OS). Statistical significance was defined as p < 0.05. Results: Elevated D-dimer levels were associated with worse Eastern Cooperative Oncology Group performance status, advanced disease stages, metastasis, elevated IL-6 and CRP levels, and lower lymphocyte counts. Pre-RT D-dimer was a strong prognostic factor. Patients with D-dimer ≤ 0.3 µg/mL showed significantly superior OS and PFS (>60 months; p < 0.001), with only one event, and this remained significant in multivariate analysis (OS: HR 4.55, 95% CI 1.89–11.3; p = 0.002; PFS: HR 3.43, 95% CI 1.54–7.8; p = 0.004). Similarly, D-dimer ≤ 0.5 µg/mL was associated with improved OS (4/72 vs. 19/40 events; p < 0.001) and longer PFS, confirmed in multivariate analysis (OS: HR 4.37, 95% CI 1.72–9.86; p = 0.002; PFS: HR 3.88, 95% CI 1.67–9.1; p = 0.003), whereas levels > 0.5 µg/mL predicted worse outcomes. Using a 0.65 µg/mL cutoff, patients with D-dimer > 0.65 µg/mL had significantly shorter OS (median 25.5 months; 95% CI, 18–NA) compared with those ≤0.65 µg/mL (median not reached; p < 0.001), and this remained independently significant (OS: HR 5.10, 95% CI 1.9–13.6; p < 0.001; PFS: HR 4.68, 95% CI 1.83–11.9; p = 0.002). Conclusions: D-dimer is an accessible, non-invasive biomarker with predictive and prognostic significance in HR-positive breast cancer. Elevated D-dimer levels are suggestive of a more aggressive disease and poorer survival outcomes. This has the potential to facilitate early assessment of treatment efficacy and disease progression. This study has several limitations. Its retrospective, single-center design may introduce selection bias and limit generalizability. Although the sample size was sufficient to detect significant associations, validation in larger, multi-center cohorts is warranted to confirm the prognostic value of D-dimer.

Background/Objectives: Head and neck paragangliomas (HNPGs) are rare, typically benign, hypervascular tumors arising from neural crest cells. Although surgery is known as the primary treatment, radiotherapy (RT) is preferred for large and inoperable tumors. This study evaluated the results and safety of RT. Methods: Fifteen patients with radiologically or histologically confirmed HNPG treated with RT between 2001 and 2024 were retrospectively analyzed. Most patients received intensity-modulated radiotherapy (IMRT) with a median dose of 45 Gy. Treatment-related toxicities were graded according to CTCAE criteria. Local control (LC) was estimated with using Wilson score method. Results: With a median follow-up of 96 months, all patients achieved stable or improved symptomes, without local recurrence, resulting in a 100% LC rate. RT was well tolerated, with no acute or late toxicities ≥ grade 2. Conclusions: RT, particularly IMRT, provides excellent long-term LC with minimal toxicity in patients with HNPG. RT represents an effective and well-tolerated treatment option, especially for patients with unresectable disease or high surgical risk.

Prognostic Significance of Lymphocyte Percentage and IL-6 Level in Patients Undergoing Radiotherapy for Advanced Lung Cancer - Bezmialem Science

Background:The neutrophil-to-lymphocyte ratio (NLR) has emerged as a promising systemic inflammatory biomarker with potential prognostic value across various solid tumors. However, its prognostic significance in patients with esophageal cancer undergoing neoadjuvant chemoradiotherapy (nCRT) remains inconsistent. This study aimed to investigate the independent prognostic value of pretreatment NLR in patients with esophageal cancer treated with nCRT. Methods:This retrospective cohort study included 72 patients with stage II–IVA esophageal cancer who received nCRT between July 2020 and December 2023. Pretreatment NLR was calculated from complete blood count measurements obtained within one week before treatment initiation. The optimal NLR cutoff value was determined using maximally selected rank statistics. Overall survival (OS) and progression-free survival (PFS) were evaluated using the Kaplan–Meier method and Cox proportional hazards regression analyses. Results:The optimal pretreatment NLR cutoff was identified as 2.4 for both OS and PFS. Patients with an NLR >2.4 had significantly poorer PFS (p=0.013) and OS (p2.4 remained independently associated with worse PFS (HR=2.18, 95% CI: 1.09–4.37, p=0.028) and OS (HR=2.23, 95% CI: 1.11–4.49, p=0.024). In addition, poor response to nCRT was independently associated with inferior survival outcomes, whereas pretreatment NLR was not significantly associated with treatment response. Conclusions:Elevated pretreatment NLR was independently associated with poorer survival outcomes in patients with esophageal cancer treated with neoadjuvant chemoradiotherapy. Given the exploratory nature of the findings and the methodological limitations of the study, external validation using NLR as a continuous variable in adequately powered prospective cohorts is required before clinical implementation.

JOURNAL OF RADIATION ONCOLOGY AND PALLIATION

Purpose We aimed to investigate the appropriate postoperative radiotherapy dose and selective volume in T3–4 N0 laryngeal cancer patients treated with either total or partial laryngectomy. Methods Patients who received radiotherapy for locally advanced (T3–T4) and pathologic node-negative (N0) squamous cell laryngeal cancer were retrospectively evaluated. Radiotherapy was applied to median 60 Gy (range 54–60 Gy) as selective local radiotherapy (±stoma). The local treatment areas included postoperative bed + laryngeal area for patients with a partial laryngectomy, and the postoperative bed only for patients with total laryngectomy. Results The median follow-up time was 59 months and 52 patients were included. The 2‑year, 5‑year, and 8‑year locoregional recurrence controls (LRC) were 95.6%. The 2‑year and 5‑year OS rates were 93.8% and 78.9%, respectively. The 5‑year OS for age < 60 years was 95.8%, for above 60 years 56.5%. Conclusion Our data suggest that local selective irradiation to the postoperative bed + stoma is enough in patients with T3–4 N0 laryngeal cancer without applying elective nodal irradiation.